Problem: Children living in low-income communities face barriers to health care that their peers in wealthy neighborhoods do not. While these children often get the care they need for life-threatening and chronic health conditions, many aren’t treated for subacute problems like ringworm, tooth decay, and poor vision.
Background: Bob Atkins, Ph.D., M.S.N., B.S. N., has devoted his adult life to children.
He spent the early part of his career as a school nurse in East Camden, N.J., a poverty-stricken urban area just a few miles from his suburban hometown in Cherry Hill. He later co-founded a youth development program for underserved teenagers that blends meaningful activities like tree planting and soccer with academic work—and includes an annual summer retreat in Vermont. Now an assistant professor of nursing at Rutgers, the State University of New Jersey, Atkins researches the effects of class on children’s health.
He even spent his first date with his future wife surrounded by kids: He took her ice-skating with about three dozen members of his youth development program on Christmas Eve 12 years ago. She loved it—and him, and they’re now raising two boys of their own.
So it hit Atkins hard when one of the children in his youth development program died suddenly of a brain tumor three years ago. The boy had complained of headaches, and surely had experienced other problems such as changes in vision and mood, Atkins says, but he was never seen by a health care provider about those problems.
“What went wrong?” Atkins asks. “How did he fall through gaps?”
It’s the kind of question Atkins has asked himself ever since his career began.
As a school nurse in East Camden, Atkins got a good look into the relationship between class and health. He noticed that while the low-income students that he cared for were often treated for life-threatening and chronic health problems, they weren’t always treated for subacute problems like ringworm, tooth decay, and poor vision—even though they too affect children’s health, mood and ability to learn.
Low-income parents love their kids, Atkins says, but they encounter numerous obstacles in addressing their children’s subacute health problems: They work non-traditional hours, hold multiple jobs, or face linguistic, cultural or educational barriers to care.
Solution: A professor, Atkins decided to put his research skills to work and find a scientific solution to the problem. With support from the Robert Wood Johnson Foundation (RWJF), Atkins commenced a research project to better understand how poverty affects children with routine health problems.
“We know a lot about what kids do when they engage in risky behaviors,” Atkins says. “But I wanted to get a better sense of what they are doing outside of the formal health care system to promote their health. Who do they tell about their problem? How do they decide that it is time to go to the emergency room, the doctor, or the dentist? And when do they just decide to take Tylenol to ease the pain?”
To answer those questions, Atkins interviewed 30 high-school aged youth from low-income families in New Jersey about how they manage their health.
He learned three central tenets about their behavior. First, even though they are minors, these children make most decisions about their health without the aid of a parent.
Second, he discovered that these children do not have a sufficient understanding of the consequences of the decisions they make about their health. They do not understand, for example, that a tooth will not grow back if it is extracted to relieve dental pain, he says.
And finally, health communication is not always clear. These children do not always fully grasp what their providers are telling them, and their parents are not there or are not able to sort it out. At the same time, these children often give their providers unreliable information about their health.
“It was very surprising,” Atkins says. “In my experience as an adolescent, my parent was always there. I was in the room, but the provider was conversing with my parent. These kids were very clear that they were the ones making decisions.”
Atkins now plans to take the data from his research and explore ways to help children better manage their health. A first step is to revise a health education class at a nearby high school so that it includes important information about dental care. He also plans to broaden the scope of his research by analyzing a large dataset to better understand the effects of neighborhood poverty on children’s health nationwide.
RWJF Perspective: The Foundation has a longstanding interest in narrowing disparities in health and health care. As part of this mission, RWJF gave Atkins a Nurse Faculty Scholar award to collect and assess data about low-income children’s health. Atkins was one of 15 junior faculty nationwide to receive the award in 2008; he is receiving $350,000 over three years to support his research and career.
The Nurse Faculty Scholar program aims to strengthen the academic productivity and overall excellence of nursing schools by developing the next generation of leaders in academic nursing. Through RWJF, the program is providing $28 million over the next five years to outstanding junior nursing faculty to promote academic careers and reduce the national nurse and nurse faculty shortages. Atkins is one of them.